Purchasing groups, wellness among concerns tackled at summit

More than 600 attendees of Crain's Health Care Leadership Summit on Oct. 20 gathered into about 65 groups to discuss the summit's four main topics: employer health care purchasing groups, wellness programs, the state insurance exchange and the future of employer-sponsored health benefits.

Most people agreed employers need to band together to get lower health care prices and drive quality improvements. Some disagreed, saying there isn't enough desire among business leaders.

Barriers include lack of CEO leadership, lack of unity, loss of employer control of health benefit plans and health insurance carrier opposition.

Participants agreed key CEOs and companies need to lead and invest in coalition infrastructure.

Driving formation of the employer coalition should be the auto industry, namely the Automotive Industry Action Group. The Health Care Value Task Force, created last year within AIAG, should develop into a separate health care purchasing coalition.

If formed, the employer purchasing group should contract directly with hospitals, physicians and other providers for greater health care cost discounts. Others said contracting with single or multiple payers could lead to savings.

Some voiced concerns about the effects of squeezing profit margins of hospitals, physicians and other providers.

Aside from AIAG, other groups leading this effort could include the Economic Club of Detroit, Mackinac Republican Leadership Conference and Automation Alley.

Topic 2: Are worksite wellness programs a good investment?

Most people agreed that wellness programs offer good preventive health measures for employees, increase worker productivity and lower absenteeism rates.

But participants said the expense requires a big investment for employers, and it's hard to document the return on investment or other direct financial benefits.

Some participants said return on investment should include lower premiums that come from a healthier and more productive workforce.

Currently, many wellness programs offer financial incentives based on participation.

Low participation rates for programs like Weight Watchers, smoking cessation, yoga and stress counseling could be addressed through use of social media.

But some believe wellness programs should move toward financial rewards for good behavior, including weight loss, smoking cessation and lower cholesterol counts. Those improved outcomes should be rewarded with lower insurance premiums.

Wellness programs should include programs that help improve an employee's emotional, physical and financial well-being.

Companies should consider higher premiums or monetary surcharges for employees who smoke or are obese.

Using health risk assessments with medical consultation, wellness programs can help employees identify chronic diseases in early stages that can lower costs.

Topic 3: Should Michigan create a health insurance exchange or allow the federal government to set one up?

Most participants preferred that Michigan create its own exchange. The Legislature is debating Senate Bill 693 that would create the exchange.

Some said the state needs to keep administrative support for the exchange in Michigan and avoid contracting to out-of-state companies for claims processing, bill collecting and information technology development.

Essential benefits offered in the four plans offered in the exchange should include preventive, wellness, vision, dental, pharmacy and mental health. Plan types should include high-deductible, HMOs and PPOs.

Existing health insurance agents should be used to help people and businesses select plans.

Concerns were voiced about avoiding conflict of interest in the makeup of a seven-member exchange board appointed by the governor, whether access to primary-care providers will be sufficient and whether regulations within the exchange will be the same as in the private market.

Topic 4: Will employers drop health coverage benefits once the state health insurance exchange is up and running in 2014?

Consensus seemed to be that each employer will decide whether to keep or drop health care benefits based on financial impact on employees and the company. In other words, there's lots of math to be done once plans are known, probably in mid-2013.

But most employers with fewer than 50 workers, excluding such professional firms as lawyers, physicians or architects, most likely will drop their small-group coverage and allow some workers to lower their premiums through federal subsidies.

Employers in competitive industries will think twice about dropping coverage for fear of losing employees to competitors.

The impact of exchanges is unclear on hospitals, physicians and other health care companies that must absorb payment cuts in exchange for more insured patients.

Some employers could move to keeping a workforce under 50 workers by moving to contract workers or outsourcing.

Larger companies will keep health benefit coverage but continue efforts to control costs and improve quality.

The possibility of a Republican becoming president in 2012 could lead to the dismantlement of the Affordable Care Act. The U.S. Supreme Court also could rule all or parts of the act unconstitutional.